The Impact of Direct Oral Anticoagulant Prophylaxis for Thromboembolism in Thrombophilic Patients Undergoing Abdominoplastic Surgery

The Implementation of Perioperative Geriatric Management Could Decrease the Incidence of Postoperative Delirium in the Elderly Undergoing Major Orthopedic Surgeries

OBJECTIVES

This study aimed to explore the association of perioperative geriatric management (PGM) in major orthopedic surgeries.

METHODS

One hundred seventy-five participants aged 75 and older were in-hospital patients who underwent major orthopedic surgery from September 2020 to September 2021, and they received PGM and necessary treatment for indicators with abnormal value (the PGM group). Another 175 participants in the control group only received the evaluation part of the PGM, recruited by filtering in the electronic medical record system from March 2016 to March 2017. The treatment included joint intervention of psychiatrists and rehabilitation physicians. For example, for patients at risk for falling, evaluation of inadequate blood volume, delirium, abnormal gait, and visual impairment should be performed. The logistic regression analysis was adopted to determine the association of PGM and postoperative delirium.

RESULTS

The prevalence of postoperative delirium among participants was 13.71%. Compared with the empirical treatment group, the postoperative delirium was significantly decreased (7.43% versus 14.29%) ( P <0.05). Compared with the control group, participants were in the PGM group were at lower risk of postoperative delirium, mainly attributed to these following factors: Charlson comorbidity index <5 [odds ratio (OR)=0.620; 95% CI: 0.010-0.623], mini cog >2 (OR=0.224; 95% CI: 0.061-0.824), Confusion Assessment Method score indicating low risk (OR=0.079; 95% CI: 0.010-0.623), nutritional risk screening scale <3 (OR=0.306; 95% CI: 0.095-0.989), and major adverse cardiovascular events <3 (OR=0.253; 95% CI: 0.073-0.720). After adjusting for the length of hospital stay and reason for hospitalization, the association between the parameters above and postoperative delirium is still significant ( P <0.05).

CONCLUSIONS

The implementation of the PGM could decrease the incidence of postoperative delirium significantly, which might contribute to improving the overall prognosis in elderly patients who underwent major orthopedic surgeries.

Decreasing Venous Thromboembolism With Anticoagulation in Plastic Surgery

Introduction: Venous thromboembolism (VTE) is a devastating complication in aesthetic plastic surgery. Plastic surgeons are advised to approach VTE prevention proactively by modifying the perioperative risk profile of their patients. Herein, the authors review the evidence of pharmacologic prevention of VTE in plastic surgery, caution surgeons that blanket treatment based on Caprini score alone should be avoided, and advocate for case-by-case individualized therapy for every patient. Methods: A review of evidence for the pharmacologic prevention of VTE in plastic surgery was performed. Results/Conclusion: A proactive approach to VTE prevention can be achieved by employing both nonpharmacologic and pharmacologic evidence-based interventions. While the choice to use anticoagulation medications should be guided by calculation of a Caprini score for each patient, surgeons should continue to maintain their clinical judgment to prevent complications from over and under treatment.

Mondor’s disease as a complication in breast surgery in a male patient. The first ever reported case in literature

Mondor’s disease (MD) is an uncommon clinical condition characterized by thrombophlebitis of the superficial veins of the anterolateral thoracoabdominal wall. In this paper we present the first ever reported case of Mondor’s disease in male patient after surgical correction of gynecomastia with liposuction assisted skin sparing adenectomy.